Suggestions for Improving Behavioral Health Services for Older Adults Receiving Long Term Care

Summary of Comments from the New Directions in Geriatric Behavioral Health for Long Term Care Conference on October 16, 2003

Staff/ Professional/Caregiver Improvements

• Find ways to provide education and support for staff especially aides.
• Make it mandatory for managers in senior housing to get training about mental health problems, treatment and services.
• Upgrade the education requirements for nursing aides with higher grade of pay.
• Get better qualified people to provide out-patient services when the patient is released from a facility. When visiting offices that provide mental health services, the staff seems to be more involved in getting through the visit to get another patient rather than trying to help. Much better screening of the staff needed.
• Professionals need to hear more from speakers like Mr. Nieves and Hikmah Gardiner. Both are a source of inspiration as they relate their stories of pain and victory to remind us why we are in this field.
• We could have a gathering of professionals to teach each other through practice at the conference what would be helpful like demonstrating techniques.
• Ask ourselves where they see themselves in 10, 20 years. Is this what they would want?
• Start training programs to teach "young-old" to work with "old-old" with dementia. Teach facilities to hire older workers in 4-hr. shifts, rather than 8 hour.
• Provide basic mental health and aging training to all direct caregivers- (family or staff; in-home or facility based).
• Develop depression intervention "kits." For direct caregivers (family or staff). Distribute through both mental health and aging systems.

System Changes

Approach our Congressional representatives for increasing funding for improving behavioral

• health for older adults.
• Medicare clients need to be provided with all mental health services.
• More funding needs to be available for mental health services in long term care.
• Medicare and Medicaid funding must increase funding for long term care and to reimburse commensurate with intensity of care required for those with behavioral health issues.
• Have Medicare and Medicaid payment systems fund mental health services in long term care settings. (Make PDA waivers services available for personal care home residents.)
• Review and revise the regulations to the reality of today.
• In nursing homes, get case-mix and Rugs to reflect the skill required to cope with behaviorally distressed residents.

Treatment Changes

• With aging there are many changes forced upon us that we do not choose, and are not emotionally prepared for. I am convinced that a certain amount of what is called "depression" is a natural reaction to the things we lose. And is not necessarily "unhealthy." Can we reliably determine how much of this thing we are calling "depression" is just to be expected and just left alone and when intervention is proper?
• We need more programs that allow psychiatrists (or counselors) to go out to the home for those who can't or won't leave their home.
• Provide a better knowledge base to Primary Care Providers about proper referrals and availability of programs in the community for their patients.
• We need to set up PACT type team integrating aging mental health and home health. Case management should continue in nursing homes. Consumers often have no family. or supports outside of case managers. The ideal would be a case manager, care manager, home health nurse, aide, psychiatrist, and physician.
• There needs to be care managers for all those in long term with mental health needs.
• There should be more out-patient mental health programs for elderly.
• There should be intensive case management programs that would specifically with elderly.
• Develop easier access for older adults to mental health providers and treatment.
• Improve monitoring of medication for older adults by primary care providers. Many primary docs reorder med without reviewing previous meds or evaluate health conditions. Some elderly have the same meds in two or three containers with different refill dates. How can these meds be effective for the person?
• Eliminate anti-depressants- they are not the answer coupled with the side effects to the person.

Advocacy Needs

There should be lobbying for improving mental health care in long term care. There should be more advocacy for long term care clients. Advocacy to insurance companies and legislative bodies for specific mental health coverage for elderly. Advocacy for mental health treatment with primary care providers and psychiatrists.

Facilities Changes

• Facilities for elderly must be handicapped accessible.
• Personal care boarding homes need evening and weekend activities.
• Create residential settings to accommodate aid care appropriately for those chronically mental ill elders who currently reside in long term care facilities but do not need nursing care.
• Improve and transition the environment, atmosphere and structural facility whose ambiance focus is sensory, stimulation in visual, sound, aromatherapy and tactile.
• Improve the quality care of the residence raising their self-esteem by way of how they feel about their physical self in appearance- offer manicures, pedicures, hair styling, massages, wardrobe dressing, live entertainment consistently in house and out in the community.
• Increase and upgrade the use of alternative placements outside of nursing homes. As an example, a facility that offers residential living for "seasonal citizens" that have health care and mental health components in independent living, C.L.A.s

Other Ideas

• Primary caregivers should be given a stipend for caring for older adults at home.
• I would like to see a forum of discussion between representatives from Older Adult services, OMH/MR, D7A to address the needs of the elderly. This would include service delivery, funding, systems barriers etc.
• For nursing home residents can we have an extension of the Senior Companion Program (PCA) where they can visit the isolated resident who has no family or whose family doesn't visit.

The Mental Health Association of SE PA does not endorse these ideas but reports them as comments received by participants of the New Directions in Geriatric Behavioral Health for Long Term Care held on October 16, 2003.

These ideas will be reported to the Mental Health and Long Term Care Task Force for recommendations for action.

Return to: Mental Health and Aging: October 16, 2003 Conference, Introductory page